Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study

Abstract

Introduction: Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess.

Research question: The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance.

Material and methods: Seventy-two residents were randomized into the simulation group (SG) and control group (CG). The course spanned five days, commencing with assessment of technical skills in basic procedures within a wet-lab setting on day 1. Over the subsequent core days, the SG engaged in simulated procedures, while the CG carried out routine activities in an OR. On day 5, all residents' technical competencies were evaluated. Psychometric measures of all participants were subjected to analysis.

Results: The SG demonstrated superior performance (p < 0.0001) in the brain tumour removal compared to the CG. Positive learning curves were evident in the SG across the three days of simulator-based training for all tumour removal tasks (all p-values <0.05). No significant differences were noted in other tasks, and no meaningful correlations were observed between performance and any psychometric parameters.

Discussion and conclusion: A brief and intensive training regimen utilizing 3D virtual reality simulators enhances residents' microsurgical proficiency in brain tumour removal models. Simulators emerge as a viable tool to expedite the learning curve of in-training neurosurgeons.

Keywords: Augmented reality; Neurosurgery; Psychometric testing; Simulation; Soft skills; Training; Virtual reality.

Fig. 1

Flow chart showing the study design. Randomization was based on the PGY and the country of neurosurgery residency. The duration of the course was 5 days. On the Pre-Training day, the participants’ abilities were tested on experimental models. During the Training days, the simulation group SG) did intensive simulation training, while the control group (CG) observed surgeries in the OR and did general activities on the neurosurgery ward and OR. During the Post-Training day, residents’ abilities were retested using the same models used during the Pre-Training. Because of technical problems with simulators, data about 5 participants was not analysed because they were not uniform.

Fig. 2

The graph shows the residents’ performance in the removal of tumour model tumour during the Pre-Training and the Post training. It illustrates the improvement of Post Training performance in the Simulation Group (SG) (p < 0.0001) compared to the Control Group (CG) (p > 0.99). *p < 0.05, **p < 0.005, ***p < 0.0005. CG = Control Group. SG = Simulation Group.

Fig. 3

The picture shows the results of tumour removal using the neurosurgical simulator. a It is notable the improvement over the three days of training in the removal of the Low Bleeding meningioma (p = 0.02). b The different performances of seniors and juniors in the Low Bleeding Meningioma removal. The first day score was the same but during the second and the third day of training the seniors performed better but there is no statistical difference (p = 0.35). c There is a sharp improvement in the removal of High-Bleeding Meningioma (p = 0.001). d Even if the seniors residents performed better than the juniors there is no difference between the groups (p = 0.5). e The performance in glioma removal increased markedly (p = 0.001). f There is no difference in the performance of the glioma removal between senior and junior residents (p = 0,7). Low-BM = Low-Bleeding meningioma, High-BM=High Bleeding meningioma, *p < 0.05, **p < 0.005, ***p < 0.0005.

Fig. 4

16 Personality factor data. a Extroversion. b Anxiety. c Hardness. d Introversion. e Self-control.